BACKGROUND: This study evaluated echocardiographic changes in full-term healthy neonates during early transitional period from postnatal 0–72 hours at 12-hour intervals by echocardiography. METHODS: This was a prospective, observational, and longitudinal single-center cohort study. Morphometric, functional, systolic, diastolic, and tissue Doppler imaging (TDI) parameters (patent ductus arteriosus [PDA], aorta, superior vena cava [SVC], stroke volume [SV], cardiac output [CO], cardiac index [CI], early diastolic flow velocity [E], late diastolic flow velocity [A], early filling in TDI [E′], peak systolic annular velocity in TDI [S′], late velocity peak in TDI [A′], and myocardial performance index [MPI]) were evaluated in left ventricle (LV) and right ventricle (RV) with 56 newborns. RESULTS: Sizes and peak velocities of PDA before postnatal 24 hours were significantly changed than those after postnatal 24 hours. Aortic velocity time integral (VTI), systolic blood pressure (BP), LV SV/kg, LV CO/kg, LV CI, and SVC flow/LV CO before 24 hours showed significantly changes than those after 24 hours. Also, LV and RV MPI before 24 hours were significantly higher than those after 24 hours. LV E/E′ was significantly higher than RV E/E′. CONCLUSION: Postnatal 24 hours is critical time for hemodynamic closure of PDA because aortic VTI, systolic BP, LV SV, LV CO, LV CI, and SVC flow/LV CO showed simultaneously significant changes after 24 hours at the same time as 24 hours of physiological closure of PDA. Chronological and dramatic changes of systolic, diastolic, and TDI parameters during early postnatal period can be used to compile normal baseline data of healthy full-term neonates.
Aorta ; Blood Pressure ; Cardiac Output ; Cohort Studies ; Ductus Arteriosus ; Echocardiography* ; Heart Ventricles ; Hemodynamics ; Humans ; Infant, Newborn* ; Prospective Studies ; Stroke Volume ; Term Birth ; Vena Cava, Superior

BACKGROUND: Although preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth. METHODS: Study data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014. RESULTS: Preterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94–9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45–6.58). CONCLUSION: We found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy.
Child ; Female ; Humans ; Infant ; Korea* ; Mortality ; National Health Programs ; Pregnancy* ; Premature Birth* ; Prognosis ; Recurrence ; Risk Factors ; Term Birth

Executive function (EF) is increasingly recognized as being responsible for adverse developmental outcomes in preterm-born infants. Several perinatal factors may lead to poor EF development in infancy, and the deficits in EF can be identified in infants as young as eight months. A prospective cohort study was designed to study the EF in Chinese preterm infants and examine the relationship between EF in preterm infants and maternal factors during perinatal period. A total of 88 preterm infants and 88 full-term infants were followed from birth to eight months (corrected age). Cup Task and Planning Test was applied to assess the EF of infants, and the Bayley Scale of Infant Development (BSID-III) was used to evaluate cognitive (MDI) and motor abilities (PDI) of infants. In comparison with full-term infants, the preterm infants performed more poorly on all measures of EF including working memory, inhibition to prepotent responses, inhibition to distraction, and planning, and the differences remained after controlling the MDI and PDI. Anemia and selenium deficiency in mothers during pregnancy contributed to the differences in EF performance. However, maternal depression, hypertension, and diabetes during pregnancy were not related to the EF deficits in preterm infants. Future research should focus on the prevention of anemia and selenium deficiency during pregnancy and whether supplementing selenium in mothers during pregnancy can prevent further deterioration and the development of adverse outcomes of their offspring.
Adult ; Anemia ; physiopathology ; Child Development ; China ; Executive Function ; Female ; Humans ; Infant ; Infant, Premature ; physiology ; Linear Models ; Male ; Memory, Short-Term ; Mother-Child Relations ; Pregnancy ; Pregnancy Complications, Hematologic ; physiopathology ; Prospective Studies ; Term Birth ; physiology

OBJECTIVE: Ultrasonography (US) is the most non-invasive, safe, and, especially in the period of infancy, best method for visualizing and examining the spinal cord. Furthermore, US is the primary work-up for development of the spinal canal, and for follow-up on issues relating to subcutaneous tissues, bone development, and the spinal cord. Conus medullaris terminates at the second lumbar vertebra, according to a consensus in the literature.METHODS: Healthy children under the age of 6 months who were admitted to the radiology clinic for routine USG follow-ups between the dates of March 2012 to December 2014 were included in this study.RESULTS: Our study includes data from 1125 lumbosacral ultrasounds. The terminal point of the conus level of the attended infants, superior, middle part, inferior of the vertebrae L1, L2, and L3. Furthermore, the termination of the discal distance ratio did not differ significantly between genders.CONCLUSION: Therefore, according to our results, gender is not an influencing factor in the termination of the spinal cord. Based on the study we performed, as well as the previous literature, in infants without a recognized spinal pathology, the spinal cord is detected below the vertebra L3.
Bone Development ; Child ; Consensus ; Conus Snail ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Methods ; Pathology ; Spinal Canal ; Spinal Cord ; Spine ; Subcutaneous Tissue ; Term Birth ; Ultrasonography

PURPOSE: To identify the potential risk factors for preterm birth (PTB) in women with advanced maternal age in the Korean population. METHODS: We selected the data of 531 pregnant women and singletons in the Korean Preterm Collaborate Network Study. Among the data, we analyzed variables related to demographic characteristics, lifestyle factors, and delivery information. Maternal age was divided into two groups: younger ( < 35 years) and advanced (≥35 years). Multiple logistic regression analysis was performed to identify the potential risk factors for PTB in advanced maternal age. RESULTS: In advanced maternal age, education level, occupation, passive smoking, iron intake, and parity showed significant differences between term birth and PTB. In particular, women who were exposed to passive smoking (odds ratio [OR]=2.83, confidence interval [CI]=1.14~7.04) and had folic acid intake during pregnancy (OR=2.67, CI=1.11~6.43) were at a significantly increased risk of PTB, after adjusting for all variables. CONCLUSION: This study indicates that smoking and lifestyle factors are the potential risk factors for PTB in advanced maternal age.
Education ; Female ; Folic Acid ; Humans ; Iron ; Life Style ; Logistic Models ; Maternal Age ; Occupations ; Parity ; Pregnancy ; Pregnant Women ; Premature Birth ; Risk Factors ; Smoke ; Smoking ; Term Birth ; Tobacco Smoke Pollution

We aimed to determine the maternal characteristics (demographics, an obstetric history, and prior cervical excisional procedure) associated with a short mid-trimester cervical length (CL, defined as a CL of ≤ 25 mm) and whether having a short cervix explains the association between these maternal characteristics and spontaneous preterm delivery (SPTD, defined as a delivery before 34 weeks). This is a single-center retrospective cohort study of 3,296 consecutive women with a singleton pregnancy who underwent routine CL measurement between 20 and 24 weeks. Data were collected on maternal age, weight, height, parity, obstetric history (nulliparity; a history of at least 1 SPTD; and at least 1 term birth and no preterm birth [low-risk history group]), and prior cervical excisional procedure. In the multivariate regression analysis, an obstetric history, prior cervical excisional procedure, and gestational age at measurement were the variables significantly associated with short CL. In contrast, maternal weight, height, age, and parity were not significantly associated with short CL. By using the likelihood of SPTD as an outcome variable, logistic regression indicated that short CL and obstetric history, but not prior cervical excisional procedure, were significantly associated with SPTD after adjustment for potential confounders. A history of SPTD and prior cervical excisional procedure were associated with an increased risk of a short mid-trimester CL. A history of SPTD, but not prior cervical excisional procedure, is associated with an increased risk of SPTD, independent of a short CL.
Cervix Uteri ; Cohort Studies ; Female ; Gestational Age ; Humans ; Logistic Models ; Maternal Age ; Parity ; Pregnancy ; Premature Birth ; Retrospective Studies ; Term Birth

OBJECTIVE: To assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population. METHODS: A retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. To compare the preterm (<37 weeks) and term births (≥37 weeks), we used unpaired t test. We assessed whether the CL measurement was dependent of gestational age by performing a linear regression and assessing the coefficient of determination (R²). We additionally assessed the accuracy of CL measurement to predict preterm birth by assessing the area under receiver operating characteristics curves with its respective confidence intervals (CIs) 95%. RESULTS: Preterm birth <37 weeks was found in 13.6% (102/751) of pregnant women. Short cervix (≤25 mm) was found in 2.7% (20/751) of pregnancies. Only 30% (6/20) of pregnant women with short cervix have used progesterone to prevent preterm birth. There was a weak correlation between CL measurement and gestational age at delivery (R²=0.01, P=0.002). Receiver operating characteristics curve analysis of the ability of CL measurement to predict preterm birth <32, 34, and 37 weeks, showed an area under the curve of 0.693 (95% CI, 0.512 to 0.874), 0.472 (95% CI, 0.353 to 0.591), 0.490 (95% CI, 0.426 to 0.555), respectively. CONCLUSION: There was a weak correlation between CL measurement and gestational age at delivery. In an unselected population, CL measurement screening at 20 to 24+6 weeks of gestation does not seem to be a good predictor of preterm birth.
Cervical Length Measurement* ; Cervix Uteri ; Cohort Studies ; Female ; Gestational Age ; Humans ; Linear Models ; Mass Screening ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women ; Premature Birth* ; Progesterone ; Retrospective Studies ; ROC Curve ; Term Birth ; Ultrasonography

PURPOSE: To compare the secular trends of gestational length distribution in singleton and twin birth by analyzing the birth certificated data of Statistics Korea. METHODS: The birth certificated data of Statistics Korea was used for this analysis (1997~99: 1,850,236 births, 2011~13: 1,325,301 births). The data of triplet birth cases, extra-marital birth, non-hospital birth cases, teenage birth, and gestational length information missing cases were excluded. Odds ratio and 95% confidence intervals were calculated from multinomial logistic regression analyses to describe the secular trend (1997~99 and 2011~13) of early preterm birth rate (≤33 weeks), late preterm birth rate (34~36 weeks), term birth rate (37~41 weeks), and post-term birth rate (≥42 weeks) adjusted for maternal age (20, 25, 30, 35, 40), birth order (1st=1, 2nd=2, ≧3rd=3), infantile gender (male=1, female=0), maternal occupation (none=1, yes=0), and education (≤middle=1, high=2, college/university=3). RESULTS: From phase I (1997~99) to phase II (2011~13), the gestational length distribution in singleton and twin births shifted the left and toward shorter gestational distribution, and mean gestational length decreased from 39.4 weeks to 38.7 weeks in singleton birth, and decreased from 36.9 weeks to 35.7 weeks in twin birth, During the period, the term birth rate of singleton birth was unchanged at 95 percent, but the term birth rate of twin birth was decreased from 65.7 percent to 46.1 percent. The odds ratio of early preterm birth, late preterm birth, term birth rate, and post-term birth rate in singleton birth for phase II were, respectively, 1.138 (95% confidence interval: 1.106~1.171), 1.556 (1.532~1.581), 1.094 (1.081~1.107), and 0.113 (0.109~0.118), compared with rate of each gestational length for phase I. The odds ratio of each gestational length in twin birth of phase II, comparing phase I, were 1.495 (1.405~1.590) for early preterm birth, 2.110 (2.029~2.194) for late preterm birth, 0.444 (0.428~0.461) for full term birth, and 0.055 (0.026-0.117) for post-term birth. CONCLUSION: The risk of early preterm birth, late preterm birth between phase I & II increased higher in twin birth than that of singleton birth. The rise in early and late preterm birth, and decrease in mean gestational length in singleton and twin birth during the period. There was a need to more research in this area to understand the contributing factors to gestational length.
Birth Order ; Birth Rate ; Education ; Humans ; Korea ; Logistic Models ; Maternal Age ; Occupations ; Odds Ratio ; Parturition* ; Premature Birth ; Term Birth ; Triplets ; Twins*

OBJECTIVE: Fertility-sparing surgery (FSS) is becoming an important technique in the surgical management of young women with early-stage epithelial ovarian cancer (EOC). We retrospectively evaluated the outcome of laparoscopic FSS in presumed clinically early-stage EOC. METHODS: We retrospectively searched databases of patients who received laparoscopic FSS for EOC between January 1999 and December 2012 at Samsung Medical Center. Women aged < or =40 years were included. The perioperative, oncological, and obstetric outcomes of these patients were evaluated. RESULTS: A total of 18 patients was evaluated. The median age of the patients was 33.5 years (range, 14 to 40 years). The number of patients with clinically stage IA and IC was 6 (33.3%) and 12 (66.7%), respectively. There were 7 (38.9%), 5 (27.8%), 3 (16.7%), and 3 patients (16.7%) with mucinous, endometrioid, clear cell, and serous tumor types, respectively. Complete surgical staging to preserve the uterus and one ovary with adnexa was performed in 4 patients (22.2%). Two out of them were upstaged to The International Federation of Gynecology and Obstetrics stage IIIA1. During the median follow-up of 47.3 months (range, 11.5 to 195.3 months), there were no perioperative or long term surgical complications. Four women (22.2%) conceived after their respective ovarian cancer treatments. Three (16.7%) of them completed full-term delivery and one is expecting a baby. One patient had disease recurrence. No patient died of the disease. CONCLUSION: FSS in young patients with presumed clinically early-stage EOC is a challenging and cautious procedure. Further studies are urgent to determine the safety and feasibility of laparoscopic FSS in young patients with presumed clinically early-stage EOC.
Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Female ; *Fertility Preservation ; Humans ; Laparoscopy ; Live Birth ; Neoplasm Recurrence, Local/blood/diagnosis/*therapy ; Neoplasm Staging ; Neoplasms, Glandular and Epithelial/drug therapy/*pathology/*surgery ; *Organ Sparing Treatments ; Ovarian Neoplasms/drug therapy/*pathology/*surgery ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Term Birth ; Treatment Outcome ; Young Adult

PURPOSE: This study was performed to explore the weight variations in high-risk term newborns hospitalized during the early postnatal period. METHODS: A retrospective explorative study was performed with 64 term newborns who were hospitalized in the NICU after birth. Data on daily weight, birth information, and clinical features such as phototherapy, placements, nutritional status were reviewed through medical records for 14 days of life. General Linear Model, GLM was applied to analyze the weight variation by clinical features of these high-risk term newborns for 14 days of life. RESULTS: Newborns at 40 weeks of gestation showed little weight loss during the few days after birth then steadily gained weight to 7.6% at the 14th day. Infants born at 37-39 gestation showed little weight gain for 14 days though the weight loss itself was not apparent. As well, return to birthweight was not observed in newborns with phototherapy, infants placed on a warmer or infants having gastrointestinal dysfunction for 14 days of life. CONCLUSION: Even for term newborns, physiologic weight loss may not be warranted even if newborn is born at less than 40 week of gestation, or with high-risk conditions that warrant admission to NICU.
Birth Weight ; Humans ; Infant ; Infant, Newborn* ; Intensive Care Units, Neonatal ; Linear Models ; Medical Records ; Nutritional Status ; Parturition ; Phototherapy ; Pregnancy ; Retrospective Studies ; Term Birth ; Weight Gain ; Weight Loss